MEDICARE: MRS. DANIELLE ERVIN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P15034	NC

General Provider Information

NPI Number	:	1366398083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE ERVIN PT, DPT

Provider Business Mailing Address
First Line	:	6716 SOMERKNOLL DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-6397
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 BACON ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-5006
Country	:	US
Telephone Number	:	919-560-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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